吲哚菁绿15分钟滞留率对肝癌合并门静脉高压症患者经颈静脉肝内门体分流术后肝性脑病发生风险的预测价值

目的分析吲哚菁绿15 min滞留率(ICG-R15)、Child-Turcotte-Pugh(CTP)分级和终末期肝病模型(MELD)评分预测肝癌合并门静脉高压症患者经颈静脉肝内门体分流术(TIPS)后肝性脑病(HE)发生的临床价值。方法回顾性分析2015年1月-2017年6月在首都医科大学附属北京世纪坛医院经TIPS治疗的95例肝癌合并门静脉高压症患者的临床资料,根据TIPS术后是否发生HE分为HE组(n=24)和非HE组(n=71);所有患者术前均进行ICG-R15测定、CTP分级、MELD评分。计量资料满足正态分布的2组间比较采用t检验,不满足正态分布的2组间比较采用Mann-Whitney U检验,计数资料2组间比较采用χ^2检验和Fisher精确检验。采用单因素、多因素logistic回归分析TIPS术后HE发生相关的危险因素。采用受试者工作特征曲线(ROC曲线)分析比较ICG-R15、CTP和MELD评分对HE发生的预测价值。结果TIPS术后12个月内HE发生率为25.2%(24/95)。logistic单因素分析显示,TIPS术后HE发生的相关因素有支架位置(P=0.021)、ICG-R15(P=0.005)、CTP分级(P=0.040)。多因素分析显示支架位置为门静脉右支(OR=3.373,95%CI:2.346~5.103,P=0.010)、ICG-R15>30%(OR=2.107,95%CI:1.331~3.212,P=0.036)是预测肝癌合并门静脉高压症TIPS术后HE发生的独立危险因素。ROC曲线分析显示,ICG-R15、MELD评分和CTP分级预测TIPS术后HE发生的ROC曲线下面积分别为0.659、0.638和0.621。结论ICG-R15对肝癌合并门静脉高压症患者TIPS术后HE发生风险有一定的预测价值。

Value of indocyanine green retention rate at 15 minutes in predicting the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in liver cancer patients with portal hypertension

Objective To investigate the clinical value of indocyanine green retention rate at 15 minutes(ICG-R15),Child-Turcotte-Pugh(CTP)class,and Model for End-Stage Liver Disease(MELD)score in predicting post-transjugular intrahepatic portosystemic shunt(TIPS)hepatic encephalopathy(HE)in liver cancer patients with portal hypertension.Methods A retrospective analysis was performed for the clinical data of 95 liver cancer patients with portal hypertension who underwent TIPS in Department of Interventional Therapy in Beijing Shijitan Hospital from January 2015 to June 2017,and according to the presence or absence of HE after TIPS,they were divided into HE group with 24 patients and non-HE group with 71 patients.ICG-R15,CTP class,and MELD score were determined for all patients before surgery.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test and the Fisher’s exact test were used for comparison of categorical data between two groups.Univariate and multivariate logistic regression analyses were used to investigate the risk factors for HE after TIPS,and the receiver operating characteristic(ROC)curve was used to analyze the value of ICG-R15,CTP class,and MELD score in predicting HE.Results The incidence rate of HE was 25.2%(24/95)within 12 months after TIPS.The univariate analysis showed that stent location(P=0.021),ICG-R15(P=0.005),and CTP class(P=0.040)were associated with HE after TIPS.The multivariate analysis showed that stent located in the right portal vein(OR=3.373,95%CI:2.346~5.103,P=0.010)and ICG-R15>30%(OR=2.107,95%CI:1.331~3.212,P=0.036)were independent risk factors for HE after TIPS in liver cancer patients with portal hypertension.The ROC curve analysis showed that ICG-R15,MELD score,and CTP class had an area under the ROC curve of 0.659,0.638,and 0.621,respectively,in predicting HE after TIPS.Conclusion ICG-R15 has a certain clinical value in predicting HE after TIPS in liver cancer patients with portal hypertension.